How to Get to the Bottom of a Suspicious Worker's Compensation Case

Workers compensation insurance was created to protect both employees and employers. Injured workers are entitled to payment of medical expenses and lost wages, while insured companies don't have to pay these costs out of pocket. Unfortunately, a small amount of people try to exploit the system and obtain benefits dishonestly. Here's how you can uncover suspicious workers comp claims at your business.

1. Monitor the Environment

There's no better proof one way or another than a video recording of what actually took place. You should put a system in place to cover as much square footage as possible and automatically archive the footage for later review or deletion. In 2015, a woman in Ft. Lauderdale, Florida, filed a claim maintaining that a sprinkler head fell from the ceiling and struck her in the forehead. Review of surveillance footage showed that the sprinkler actually fell on her desk, and she struck herself with it.

2. Keep in Touch With Workers

If you feel a workers’ compensation claim might be suspicious, reach out to the claimant's coworkers and possible witnesses for their take on the situation. Even overhead rumors and gossip may point you to the real story. If even an injured worker's colleagues feel it's suspicious, that's a good indicator that something's amiss. Become familiar with workers’ compensation laws. Make it clear that you have a no-tolerance policy toward fraud, and offer incentives for employees that can expose it.

3. Know the Warning Signs

You should understand the signs of suspicious claimants, and also communicate them to your staff. These include:

• Erratic job history
• Financial problems like child support or debt collectors
• Criminal or fraudulent events in the past
• Exaggeration of injury or symptoms
• Improbable version of events

4. Work with Your Insurance Company

If you suspect workers’ compensation fraud, contact your insurance company. They will most likely be glad to start their own investigation. Give them the full details as you understand the case, and cooperate with them in any way you can. Many states will also have their own hotlines for reporting fraudulent claims, or medical professionals who abet them. Fraudulent workers comp claims are a growing crime in America. Billions of dollars in bogus claims are paid out every year. This forces insurers to charge higher premiums, which drains business profits and leads to slower growth and lower wages. In most cases, higher costs are passed on to the consumer. It's in everyone's best interests to take a closer look at any doubtful claims made by your employees.